Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Kentucky for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Kentucky only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Kentucky (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Communicare Inc (NPI 1891832234)

Field	Value
Entity Type	Organization
Organization	Communicare Inc
Address	320 Ring Rd
City	Elizabethtown
State	KY
ZIP	42701
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	February 1, 2007

Payer Source	Total Paid
Medicaid	$205.5M
Medicare	$0

Key Findings

COMMUNICARE INC is effectively a single-payer Medicaid provider: it reports no Medicare billing on file and $205.5M in lifetime Medicaid revenue, indicating its clinical and financial footprint is concentrated entirely in the Medicaid program. This payer concentration makes the organization sensitive to state Medicaid policy and waiver program changes.

Revenue is heavily concentrated in a very small set of services: the precomputed top three codes account for 76.1% of the provider's total Medicaid revenue. Those top drivers are 97535 ($100.1M, 48.7% of Medicaid revenue), T2016 ($31.1M, 15.1%), and T1019 ($25.2M, 12.3%), showing a tight dependence on a few high-volume/ high-revenue codes.

The code mix points to a business model focused on home- and community-based habilitation and therapy/instructional services rather than traditional clinic- or acute-care billing: 97535 is a high-volume therapeutic/instructional procedure, T2016 is a residential habilitation per diem tied to waiver programs, and T1019 covers personal care services per 15 minutes. Together these codes suggest COMMUNICARE operates large-scale waiver, day habilitation, personal care, and therapy programs serving community-based populations.

97535 is the single largest revenue and volume driver by a wide margin, with 962.3K claims, $104 avg paid/claim, and $100.1M revenue; the provider ranks #2 of 305 in-state and is labeled an "extreme outlier" (100th percentile). This standing indicates COMMUNICARE is a dominant statewide operator for this specific therapeutic/instructional service and performs at volumes far above typical state providers.

Beyond 97535, the provider also reports very large utilization in waiver and day services: T2016 has 151.5K claims and $31.1M revenue (rank #10 of 146, 94th percentile, "notably above typical state volume"), T2021 has 173.1K claims and $11.1M revenue (rank #2 of 150, 99th percentile, "extreme outlier"), and T1019 has 224.9K claims and $25.2M revenue (rank #8 of 51, 86th percentile). These volumes reflect a broad suite of habilitation and personal-care offerings (including day habilitation and residential waiver services) that are central to the organization’s Medicaid business.

The provider also delivers substantial care-management and administrative waiver services at scale: T2022 (case management, per month) generated $14.5M with 52.8K claims and ranks #4 of 81 (96th percentile, "notably above typical state volume"), while T2040 (financial management, self-directed) contributed $5.7M and ranks #5 of 43 (90th percentile). These figures show that COMMUNICARE’s operations include ongoing case management and financial-management support for self-directed waiver enrollees, not just direct care delivery.

Competitive posture across codes is mixed but weighted toward dominance in several Medicaid HCBS categories: the provider is an extreme outlier or near the top for multiple high-revenue codes (97535 at 100th percentile, T2021 and T1005 at 99th percentile), while other codes such as S5108, H0004, and T1999 sit at more typical percentiles (67th, 61st, and 31st respectively). In aggregate, this pattern characterizes COMMUNICARE as a major statewide player for core habilitation and therapy services, but more ordinary in some ancillary service lines.

COMMUNICARE’s NPI was enumerated on 2007-02-01 (~19 years ago), signaling long tenure in the market; coupled with $205.5M in Medicaid revenue and the provider’s ranking outliers, this suggests an established operational footprint in Kentucky’s community/behavioral health and waiver services market. The combination of long tenure and concentrated, high-volume Medicaid activity implies organizational scale that is specifically geared to Medicaid-managed and waiver populations.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	962,320	$100	$100.1M
T2016	Habilitation, residential, waiver; per diem	151,530	$210	$31.1M
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	224,860	$110	$25.2M
T2022	Case management, per month	52,760	$280	$14.5M
S5108	Home care training to home care client, per 15 minutes	129,590	$90	$11.9M
T2021	Day habilitation, waiver; per 15 minutes	173,070	$60	$11.1M
T2040	Financial management, self-directed, waiver; per 15 minutes	54,350	$110	$5.7M
T1005	Respite care services, up to 15 minutes	95,540	$60	$5.6M
H0004	Behavioral health counseling and therapy, per 15 minutes	3,060	$90	$272K
T1999	Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks"	550	$130	$74.2K

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.

Claims Volume vs. Kentucky Distribution

Communicare Inc — 4 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

10 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5108	Home care training to home care client, per 15 minutes	34	100	43,820	$140	$16.6M
T2016	Habilitation, residential, waiver; per diem	10	150	42,680	$190	$11.3M
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	8	50	13,600	$140	$11.1M
T2022	Case management, per month	4	80	7,120	$290	$4.1M
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	2	310	830	$120	$3.7M
T2040	Financial management, self-directed, waiver; per 15 minutes	5	40	14,910	$160	$3.5M
H0004	Behavioral health counseling and therapy, per 15 minutes	68	180	1,320	$220	$1.9M
T2021	Day habilitation, waiver; per 15 minutes	2	150	16,130	$70	$1.7M
T1005	Respite care services, up to 15 minutes	2	80	2,880	$70	$799.2K
T1999	Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks"	25	40	1,370	$160	$315.4K

Nearby Providers

Other providers in the same ZIP code as Communicare Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Baptist Healthcare System Inc	KY	General Acute Care Hospital	$0	$95.7M
Stepworks Recovery Centers LLC	KY	Substance Use Disorder Rehabilitation Clinic/Center	$0	$67.7M
Communicare Inc	KY	Community/Behavioral Health Agency	$0	$49.5M
Hardin Memorial Hospital	KY	General Acute Care Hospital	$0	$37.2M
Pinnacle Treatment Centers Ky-1, LLC	KY	Substance Abuse Rehabilitation Facility	$0	$33.6M
Lincoln Trail Area Development District	KY	Supports Brokerage Agency	$0	$31.4M
Astra Behavioral Health LLC	KY	Psychiatry Physician	$0	$26.1M
Renest Recovery Support Services	KY	Community/Behavioral Health Agency	$0	$19.9M
Baptist Health Medical Group Inc	KY	Internal Medicine Physician	$0	$13.7M
Elizabethtown Emergency Physicians, LLC	KY	Emergency Medicine Physician	$0	$11.9M

Communicare Inc — Billing Profile & Reimbursement Data

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Communicare Inc — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References